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I have recently been diagnosed with chiari type 1. I am very…

Customer Question
I have recently been...

I have recently been diagnosed with chiari type 1. I am very sytematic, but the past week my tounge is going numb. Is this a symtom?

Doctor's Assistant: Do you have frequent headaches? Any issues with coordination or balance?

I have had an ongoing headache for three months since I was rear ended in a vehicle accident. I can't seem to get relief from my symptoms nausea, vomiting, blurred vision( sometimes black) numbness and tingling in my hands just to name a few.

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

Daily nonstop

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

No I've been pretty healthy until recently. I would get occacional migraines, but nothing like this

Submitted: 8 months ago.Category: Neurology
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Customer reply replied 8 months ago
I am having a hard time to get any doctors to take my symptoms seriously
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Answered in 1 hour by:
9/23/2017
Neurologist: Dr Subbanna MD, Neurologist (MD) replied 8 months ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,194
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health situation. As a neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

You have asked a question, whether the recent onset numbness of the tongue could be due to chiari 1. Please see chiari malformation can cause numbness of the tongue although it is not common

I will first discuss about chiari malformation, and then address your above question again.

In chiari malformation (type 1 the commonest one), as you may already know, one of the lowermost portions of the brain called as cerebellar tonsils herniate downward (means descend abnormally downwards) and enter the spinal canal (the space normally meant for only the spinal cord).

Normally the cerebellar tonsils, being part of the brain, are supposed be present fully within the skull cavity, and they are not supposed to descend below the margins of a structure called as foramen magnum. Foramen magnum is the wide opening at the lower part of the skull through which the brain continues downwards as spinal cord, or spinal cord continues upwards as the brain. The brain structures should not descend below the margins of foramen magnum, if any part of the brain descends below the margins of the foramen magnum then it is called as herniation of the brain, and chiari malformation is one of the types of brain herniation where the structures called as cerebellar tonsils, which are the lowermost parts of the cerebellum, descend below the margins of foramen magnum

For the diagnosis of chiari malformation at least 3 mm of downward displacement of lowermost area of the cerebellar tonsils is needed. There is some controversy regarding whether at least 5 mm herniation is required or not, also whether between 3 and 5 mm to call it as borderline chiari etc.

If the patient has 3 to 5 mm or more of downward displacement then it is generally considered as chiari and if patient has no symptoms then based on the MRI finding itself, and it is considered as mild degree of chiari. The severity of the chiari does not usually correspond to the severity of the symptoms, means some patients may have minor chiari on the mri scan but may have very severe and multiple symptoms, some people may have severe chiari of the mri but have minor or no symptoms at all.

Chiari malformation is mostly treated conservatively (non-surgically). However if there are major or severe neurological manifestations that are attributed to chiari or if the chiari related symptoms are not responding to the conservative treatments and progress or worsen then also surgery is considered. So the decision on whether surgery is needed or not usually based on how severe patient’s symptoms are, and also whether the symptoms are progressing or worsening etc.

The MRI finding may not always correlate with the clinical picture. Some patients have mild chiari on MRI but experience lots of clinical symptoms and some other have more severe chiari on MRI but experience only mild symptoms.

Symptoms & treatments of chiari;

Chiari can present with myriad symptoms including headache, neck pain, neck stiffness or tightness, vertigo, dizziness, numbness, pins & needles (tingling), nausea, vomiting, blurring of vision etc. Headache is especially worse in the occipital area (back part of the head) and in the upper neck area and usually worsens with coughing or straining, and there may be discomfort in the shoulder areas too. If chiari is severe then there may be other symptoms like weakness of the arms or legs, bowel and bladder disturbances, gait difficulty etc

If the symptoms are relatively mild, if there are no major muscle weaknesses in the limbs that are attributable to chiari, and if the symptoms do not seem to be progressing in these situations nonsurgical conservative treatment is adopted, otherwise surgery is considered.

Patients with chiari are advised to avoid excessive neck movements like bending or twisting the neck, or neck exercises, major or strenuous physical activities, lifting heavy weight on the neck or shoulders or contact sports that might burden the neck area etc.

If surgery is ever needed then neurosurgeons are the ones who will do it. The surgery will involve what we call as spinal canal decompression during which more space is created in the spinal canal to accommodate the herniated portion of the brain.

Now specifically coming to your case, I see you are having multiple and severe symptoms and these have started recently. These symptoms can be due to the motor vehicle accident too. This could be post-concussion syndrome due to the recent accident. Since you have had the brain scan I assume they have already ruled out bleeding in the brain etc, otherwise you would have mentioned it here. So this could be post-concussion syndrome. Or alternatively chiari may be contributing too, or this could be a combination of chiari and post-concussion syndrome too.

And coming to the new onset numbness issues, it is possible for chiari to cause numbness but usually it is seen when there is severe form of chiari, but as I had mentioned earlier the severity of chiari may not always correspond to the symptoms, so even if you have mild chiari the numbness can be secondary to chiari. So it is certainly a possibility to explain this numbness.

If you have not seen a neurologist and/or neurosurgeon, especially after the brain scan or after the onset of this new numbness then please try to see one of these specialists so that you will receive a thorough neurological examination in the clinic followed by certain additional investigations and then treated appropriately.

Please see there are treatments for the chiari, this condition can be successfully treated. And also most of the patients who have chiari do not develop any complications so please not to be scared. Please follow the earlier mentioned recommendations and this will help in preventing worsening of the chiari and also help in preventing worsening or appearance of any new symptoms. In the meantime you may try one or more of the following treatments to help with controlling the various bothersome and annoying symptoms you are suffering from;

Massage therapy

One of the Over the counter pain relieving skin creams or ointments like - Biofreeze, Myoflex

One of the pain relieving skin patches like - Aspercreme Lidocaine Patch Max Strength (available as Over the counter, or Prescription patches like Diclofenac anti-inflammatory pain relieving skin patches, or Lidocaine anesthetic pain relieving skin patches

One of the Over the counter pain medications like Tylenol or Motrin, or Aleve

Epsom Salt Compress or Epsom Salt Soaking, or Epsom Salt Bath can help too

If symptoms do not improve with the above measures then the following additional treatment measures can be considered;

Physical therapy

Stronger prescription anti-inflammatory painkillers like Tramadol

Nerve-pain pills like Gabapentin, or Amitriptyline

Muscle relaxants like Baclofen, or Tizanidine

A course of oral steroids

Steroid Iontophoresis

Narcotic pain killer like Lortab or Percocet

Hot fomentation

Short wave diathermy

Infra-red light therapy

Ultrasound therapy

TENS (Transcutaneous Electric Nerve Stimulation)

Interferential therapy

Laser therapy (Cold laser therapy or Low Level Laser Therapy)

Medical devices such as CES (Cranial Electrotherapy Stimulation) treatment etc

I am not telling all these above mentioned treatments are required in your case; I am trying to provide a list of the various treatment options like this so that you are familiar with various treatment options that are available for your condition and you may try to use them as necessary. If you see any of the above treatments you have already tried please disregard them and you may explore the treatment options which you may have not yet tried.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Neurologist: Dr Subbanna MD, Neurologist (MD) replied 8 months ago

Hi, Do you have any additional health questions? Do you want to discuss your health situation further? Please let me know and I am available here.

Assuring you the best services!

Thanks & Best Regards!

Dr Subbanna MD

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Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,194
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Experience: American Board Certified Neurologist, Internal Medicine

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